Medications

• study of drugs

Pharmacology

• how body deals with drugs (absorption, distribution…)

Pharmacokinetics

• what drug does to body 

Pharmacodynamics

• study of harmful effects of drugs 

Toxicology

• ratio of median effective + median toxic dose | higher ratio = safer drug

Therapeutic Index

• not able to feel 

  • Side effects

    • Confusion, lethargy, disorientation

    • Bradycardia

    • Hypotension 

    • Hepatic + renal toxicity 

    • Muscle weakness

  • PT implications → 24-48 hrs post-surgical residual effects 

Anesthesia

• morphine, hydrocodone, oxycodone, codeine 

  • Side effects

    • Sedation, drowsiness

    • Orthostatic hypotension

    • Respiratory depression 

    • Nausea/vomiting

    • Constipation 

    • Euphoria 

  • Patient controlled analgesia (PCA pump): morphine 

Opioid Analgesics

• ibuprofen (motrin, advil), aleve, toradol, celebrex

  • side effects (cardio + GI)

    • Gastropathy 

    • Nephropathy 

    • Risk of clot formation → CVA + MI

    • Decreased angiogenesis → delayed muscle/bone healing

NSAIDs

• anti-inflammatory + antipyretic + analgesic + anticoagulant

  • Side effects

    • Gastric ulcers, hemorrhage 

    • Decreased clotting → increased risk of hemorrhagic stroke

    • Sodium retention + edema 

    • Hypertension 

Aspirin

• not an anti-inflammatory 

  • 1st line for PT musculoskeletal pain

  • Side effects = hepatotoxicity, hepatic necrosis 

• PT Implications

  • Pt education on differences in meds 

  • Monitor BP and GI symptoms 

Acetaminophen (Tylenol)

• anti-inflammatory → cortisone, prednisone

  • Treats: autoimmune diseases, COPD, significant flare ups 

  • Side effects

    • Breakdown of support tissues → myopathy, tendinopathy

    • Reduced bone density 

    • Weight gain 

    • Hypertension 

    • Insulin resistance, hyperglycemia, DM

    • Gastritis, ulceration 

    • Adrenocortical suppression (body unable to respond to stress)

    • Immunosuppression 

Corticosteroids

• Aspirin

• Acetaminophen

• Ibuprofen (Motrin, Advil)

• Aleve

• Toradol

• Celebrex

NSAIDs

• Morphine

• Hydrocodone

• Oxycodone

• Codeine

Opioids

Spasticity tx: exaggerated muscle stretch reflex due to spinal cord/brain damage 

• Baclofen

• Dantrolene Sodium

• Valium

• Gabapentin

• Botulinum Toxin (botox)

Muscle Relaxers

• SCI, MS

  • Side effects

    • Drowsiness

    • Dizziness

    • Muscle weakness 

    • Ataxia 

    • Blurred vision 

Baclofen

• severe spasticity 

  • Side effects: muscle weakness, hepatotoxicity 

Dantrolene Sodium

• spasm, spasticity 

  • Side effects: impaired motor control, sedation 

Valium

• antiepileptic → SCI, MS, pain management for chronic neuropathy 

  • Side effects

    • Fatigue

    • Dizziness

    • Ataxia

    • Edema 

Gabapentin

• spasticity, torticollis, migraines 

  • Side effects 

    • Muscle weakness

    • Dysphagia 

    • Urinary incontinence 

    • Respiratory depression 

Botulinum Toxin (Botox)

• acute musculoskeletal injury (low back pain)

  • Side effects 

    • Dry mouth 

    • Sedation

    • Dizziness 

    • Tolerance + dependence 

Methocarbamol

increased tension in muscle due to musculoskeletal or nerve root injury 

• Valium

• Methocarbamol

Spasm Tx

• Antihypertensives

• Statins

Cardiopulmonary Meds

• Diuretics

• Beta Blockers

• ACE Inhibitors

• Alpha Blockers

• Calcium Channel Blockers

PT implications 

• Monitor BP + HR

• Pt education on hydration + lifestyle changes

Antihypertensives

• lasix

  • Side effects 

    • Fluid, electrolyte depletion

    • Weakness

    • Fatigue 

    • Gout 

    • Osteoporosis 

Diuretics

• metoprolol → vasodilation + ↓ cardiac output

  • Uses: HTN, angina, post MI, arrhythmias, CHF

  • Side effects

    • Bradycardia 

    • Orthostatic hypotension

    • Fatigue 

    • Change in cardiovascular response to exercise 

    • Bronchoconstriction 

Beta Blockers

• vasodilation

  • Side effects 

    • Orthostatic hypotension

    • Reflex tachycardia 

Alpha Blockers

• lisinopril → vasodilation without ↓ cardiac output 

  • Side effects 

    • Dry cough

    • Hypotension 

ACE Inhibitors

• vasodilation 

  • Uses: angina, DM, ventricular arrhythmias

  • Side effects 

    • Foot/ankle edema 

    • Orthostatic hypertension

    • Increase risk of MI

    • Reflex tachycardia 

Calcium Channel Blockers

• lipitor → lipid lowering  

  • Optimal lipid levels 

    • Total cholesterol

    • LDL (bad)

    • HDL (good)

    • Triglycerides

  • Statin side effects 

    • Myopathy 

    • Hepatotoxicity 

Statins

• ↓ 200

Total Cholesterol

• ↓ 100

LDL (bad)

• ↑ 40 men, ↑ 50 women

HDL (good)

• ↓ 150

Triglycerides

• characterized by chest, neck, jaw, shoulder, back, or arm pain due to myocardial ischemia → sudden onset, last 30 secs - 20 mins

  • Antithrombotic therapy: aspirin, statins, ACE inhibitors 

  • Antianginal: vasodilators = nitroglycerin

  • Beta blockers: decrease cardiac workload 

  • Calcium channel blockers  

Angina Pectoris

• cardiac output insufficiency 

  • ACE inhibitors: vasodilator 

  • Diuretics: decrease cardiac workload 

  • Beta blockers: inhibit adverse effects of SNS activation 

  • Inotropic agent: digoxin → increases cardiac output

CHF

• inhibit clot formation + DVT treatment

  • Heparin = acute | warfarin (coumadin): longer term

Anticoagulants

• prevents TIA, CVA, MI → aspirin + plavix 

Antithrombotics

• clot busters 

Thrombolytics

• Anticoagulants

• Antithrombotics

• Thrombolytics

Coagulation Disorders